This article discusses the concept of care ethics in nursing practice through a case study. It explores the ethical dilemmas and conflicts that arise in providing care to patients and emphasizes the importance of incorporating patient values and autonomy in decision making.
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Running head: CARE ETHICS Name of the Student Name of the University Author Note
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1CARE ETHICS Introduction: In general, the ethics are defined as principles, values, and care which enable a person to live a morally good life.The term care ethics refer to the idea concerning both the nature of mortality and normative ethical theory (Vryonideset al.2016). As discussed by Mill et al. (2016), it is a feminist philosophical perspective that uses a relationship as well as context bound approach toward morality along with decision making.The care ethics in the nursing practice is highlighted as one of the crucial parts of the standard practice which share many principles with the medical ethics such as respect for autonomy and dignity, autonomy, beneficence, non- maleficence (Peter 2016).The case study represents a terminal stage of metastasis cancer of a 70-year-old single lady, Betty who was admitted to the palliative care unit for elderly care. However, during the care process, various conflict of interest and an ethical dilemma arises which affected her treatment process. The purpose of the paper is to demonstrate care ethics and nursing values with the assistance of a scenario. This paper will discuss the approach to care ethics in clinical practice, description of scenario, and ethical round of the scenario in the following paragraphs. Discussion: Themoraltheoryisknownascareethicswhichindictedthatcarefollowing professional ethics are fundamental components of a relationship and human life (Peter 2016). As discuses by Sundean, and Polifroni (2016) care ethics seek to maintain a therapeutic relationship by promoting the wellbeing of the caregiver and patients in society. It is the most crucial component of practice since it involves the meeting of the needs of others and ourselves by incorporating patient in the decision making, respecting the autonomy of the patient (Blisset
2CARE ETHICS al.2017).Considering the clinical practice, there are several ethical issues arises in the clinical setting which affected the treatment of the patient and wellbeing of the patient.Taking an insight of the situation, as discussed by Aydin, ehiralti and Akpinar (2017), care ethics is highlighted as better approach compared to other principles since it is situational based approach since it is taken into consideration the key factors that lead to the situation and provide care considering these factors without breaching the ethics for promoting the wellbeing of the patient. The care ethics influenced patient differently than other approaches because it allows the health professionals to prioritize the patient by incorporating five component of care such as care, compassion, competence, communication, courage and commitment (Blisset al.2017). Besides, it allows to design best possible care for promoting the wellbeing of the patient since they feel comfortable, empowered and safe.For this essay virtue ethics is chosen since it allows individuals to focus on the honest, braveness and moral character by providing justice (Leget, Nistelrooij and Visse 2019). This principle is better than deontological ethics is which based on the fact that whether the action is the wrong or right under a serious of rules rather than considering the consequences of the actions. Case scenario: Betty (pseudonym) is a 70-year-old single lady admitted to the palliative care unit on my placement of elderly care. She is in the terminal stages of metastatic cancer and as a result she needs assistance with her activities of daily living. Her admission notes ordered she was to be kept comfortable with medication. A special mattress was ordered to prevent skin breakdown, but the staff still need to turn her every two hours to prevent bedsores and change bed linens. Betty cried out from the pain to the extent that staff wondered if their interventions were working. Finally; The Multidisciplinary team (MDT) including me, met to decide what they
3CARE ETHICS should do. The ward manager suggested that Betty should be turned two-hourly for linen changes and to observe her skin. Noleen; a nurse on the unit for almost 15 years and acquaintance of Bettyās stated that she could not bear to hear her cry every time she was turned and suggested her sedation to be increased to reduce her pain and facilitate linen changes. Stella, a recent graduate, voiced her opinion that the patient should have some say regarding her care. Olga another nurse thought that Bettyās consultant was the one who should make the decision whether Betty should be turned; the nurses would follow his orders which the rest of the nurses objected. They argued that turning a patient, changing linen, and observing for skin breakdown are nursing measures. Actors and actions: Taking an insight into the situation, the actors of the scenario involve ward manager who suggested that Betty should be turned two-hourly for linen changes and to observe her skin. Noleen; a nurse on the unit for almost 15 years and acquaintance of Bettyās stated that she could not bear to hear her cry every time she was turned and suggested her sedation to be increased to reduce her pain and facilitate linen changes. Stella, a recent graduate, voiced her opinion that the patient should have some say regarding her care. Olga, another nurse thought that Bettyās consultant was the one who should make the decision whether Betty should be turned; the nurses would follow his orders. Other nurses who objected this situation. Ethical round of the scenario: Considering the situation, in order to prevent skin breakdown, a special mattress was ordered to prevent where nurses were required to turn her every two hours to prevent bedsores
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4CARE ETHICS and change bed linens.Here conflict of opinion observed in the situation regarding what should be the best interventions for Betty to reduce her suffering. As discussed by Gallagher et al. (2015), conflict of opinion is serious disagreement in the clinical practice which is quite common in health care. The conflict of opinion is the difficulty in utilitarian ethics which think of what makes people happy and what is good for people (Ling et al. 2017).The first priority of every actor in this situation wasBetty and her wellbeing which reflected through their suggestions and to promote the wellbeing of Betty every actor of the situation use their own values along withethics. Considering myself in this situation,I follow the virtue ethics since I believe that being a person my honesty, respect towards the patient, forgiving nature an empathy will influence the care receiver. Initially, while I met them for the discussion regarding decision making since Betty cried out from the pain, it broke my heart to see her in pain and I empathize with the patient and felt that I should involve myself in the decision making which would promote the wellbeing of the patient. I believe it is an unethical way of treating service users where they are not receiving accurate care for their wellbeing.In this case, I feel ethical sensitivity comes into play regarding the care of Betty. Considering the staff manager, he suggested that Betty should be turned two-hourly for linen changes and to observe her skin. The prime reason behind it is that maybe he thought that betty required a change of interventions for her wellbeing to which he suggested the continuous monitoring of betty to check the status of her skin. He taken into consideration the professional responsibility and accountability for the wellbeing of Betty and suggested evidence-based practice, highlighting the fact that he believed in justice (Campbell and McCarthy 2017).However, he believed in utilitarian ethics as care ethics which focuses on what makes people happy which led to the decision of observing skin, highlighting the focus on the consequences of the action.Noleen was working almost 15 years
5CARE ETHICS and acquaintance of Betty unable to bear her pain, highlighting that she had a lack of emotional control.As discussed by De Natalz and Waltz (2015) a nurse should be empathetic towards patients and compassionate with experience of the patient to provide accurate care but a nurse should be confident enough to take the best decision for the patient, ensuring that her emotions and personal values should not influence her decision. In the current context, Noleen was feeling helpless and emotional experiencing the suffering of Betty which made her provides the suggestion that her sedation to be increased to reduce her pain and facilitate linen changes. This decision reflected her nursing values such as altruism and justice. As discussed by () altruism in nursing practice defined as a selfless concern for the well-being of others.Since Noleen encountered with Betty during her care process she showed selfless concern forBetty so that her suffering can be reduced. However, as discussed by Traynoret al. (2017), while working with the patients, nurse exposed psychological distress because of their lived experience with the patients they counters which sometimes influence their decision and maybe give rise to ethical issues. In the current context, her inability to hear Betty suffering led to the decision of the increasing her sedation to be increased to reduce her pain because she wanted to see the lady have some happiness in the final period of her life. Although she thought about the wellbeing of the patient it is also influenced by her emotions and values that may give rise to an ethical dilemma (Traynoret al. 2017). Stella, a recent graduate suggested that patients should be incorporated in her practice, highlighting the fact that a patient-centered approach should be integrated into the nursing practice.As discussed by Slatyer et al. (2016), person-centered approach is one of the crucial attributes of the care of ethics which enable nurses to incorporate patients in the treatment, providing patients an opportunity to share their concern and participate in the decision making.Considering the situation, it is the responsibility of the nurse to
6CARE ETHICS incorporate Betty as a part of care ethics which would promote empowerment and comfort and shows the respect for autonomy, these values reflected through the decision of Stella when she suggested patient to incorporate in the treatment procedure (Traynoret al. 2017).Considering Ogla, who believed that Bettyās consultant should be the one who takes the best decision of her, highlighting the dependency of that nurse.She believed that Bettyās consultant knew best about her health conditions which further highlighted the dependency nature. Although a consult knew better about the patient it is the responsibility of the nurse to participate in the decision making to design best interventions for the patients (Baillie 2017). Since she believed that the consultant knew better and should take the decision alone, it may give rise to an ethical dilemma. Because of her decision rest of the nurses objected because they want to stick to their nursing values and ethics which are providing accurate and comprehensive assessment to provide comprehensive care. The incident also highlighted virtue ethics rather than utilitarian ethics that led to the conflicts. Because of the difference in values the argument existed between health professionals and it should be resolved by considering each component of care ethics and designing what should be best for the patient. Conclusion: Thus it can be the conclusion, the care ethics are extremely important attributes of nursing practice which provide a nurse to provide safe and responsive care. The exercise helped me understand that ethical nursing care crucial for providing safe and responsive care to the patient which is the prime goal of nursing. The exercise allowed me to gain an understanding of the ethics of care in clinical practice and how it should be incorporated. The paper was allowed me to reform my values and nursing practice by incorporating care ethics. The case study represents the health condition of Betty who was admitted to the palliative care department. The
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7CARE ETHICS argument took place regarding the nursing measures such as linen and observing for skin breakdown where different health professionals reflected their values. This exercise affected my learning since I went through an ethical dilemma regarding patient care and which ethics we follow virtue, deontology or Utilitarianism. After experiencing the incident that I realized that to provide care nurses should incorporate patient in the care process and take decision what is best for the patient and I will incorporate this in my future practice.
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